ACA Marketplace Take-Up Was High After Facilitated Enrollment In California; Disparities Remained.

During the unwinding of the continuous coverage requirements related to the COVID-19 public health emergency in 2023, as an unprecedented volume of consumers were transitioning out of Medicaid, California launched a facilitated enrollment program for people who lost Medicaid and were eligible for su...

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Published in:Health Affairs Vol. 45; no. 8; pp. 934 - 943
Main Authors: Hagen, Renée, Wolf, Emory, McCormick, Carolyn, Menashe, Isaac, Ravel, Katie
Format: research tables/charts Journal Article
Published: Health Affairs Publishing, LLC Aug2026
Online Access:View this record in EBSCOhost
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      dt: Aug2026
      vid: 45
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      pub: Health Affairs Publishing, LLC
      place: Washington, District of Columbia
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        atl: ACA Marketplace Take-Up Was High After Facilitated Enrollment In California; Disparities Remained.
      aug:
        au:
          Hagen, Renée
          Wolf, Emory
          McCormick, Carolyn
          Menashe, Isaac
          Ravel, Katie
        affil: Covered California, Sacramento, California
      sug:
        subj:
          Patient Protection and Affordable Care Act Legislation and Jurisprudence
          Health Insurance Exchanges
          Healthcare Disparities
          Medicaid
          Medically Uninsured
          Eligibility Determination
          Sociodemographic Factors
          State Health Plans
          Human
          Male
          Female
          Adult
          Middle Age
          California
          Nonexperimental Studies
          Descriptive Research
          Comparative Studies
          T-Tests
          Chi Square Test
          Multiple Logistic Regression
          Self Employment
          Employment, Supported
          Health Status
          Citizenship
          Written Language
          Race Factors
          Ethnic Groups
          Age Factors
          Sex Factors
          Probability
          Confidence Intervals
          Post Hoc Analysis
          Power Analysis
          Educational Status
          Health Services Accessibility
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Male
          Female
      ab: During the unwinding of the continuous coverage requirements related to the COVID-19 public health emergency in 2023, as an unprecedented volume of consumers were transitioning out of Medicaid, California launched a facilitated enrollment program for people who lost Medicaid and were eligible for subsidized Marketplace coverage. We conducted a survey in 2023-24 to assess coverage outcomes among Californians who lost Medicaid coverage, were assigned to a default plan, and had thirty days to opt in to coverage under the program. Although national surveys indicate high rates of uninsurance after loss of Medicaid, we found that 85 percent of those who were eligible for an Affordable Care Act Marketplace subsidy had some form of health insurance. Among those without other available coverage, nearly two-thirds opted in to a Marketplace plan. People with a high school education or less were least likely to enroll in Covered California, as were those who rated their health status as poor. Even after we accounted for premium amounts, income, education, health status, and language preference, take-up was higher among Asian/Asian American (84 percent) and White (79 percent) people than among Hispanic/Latino (53 percent) and Black/African American (54 percent) people. Our findings indicate that facilitated enrollment interventions should be strengthened to overcome administrative and other burdens that persist among subpopulations.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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